Functional Issues in Older Adults Jordan Bicher, D.P.T Director of Rehabilitation; Physical Therapist.

Functional Issues in Older Adults

Jordan Bicher, D.P.TDirector of Rehabilitation; Physical

Therapist

What is Function?

• The kind of action or activity proper to a person, thing, or institution; the purpose for which something is designed or exists; role

• Everyone’s Functionality is different; dependent on environment and support.

• Ultimate goal for all people is to function at a SAFE level.

• Safety is always the key.

Aging Process

• Aging is inevitable, however the pace at which we age varies based on physiology and environmental factors.

• Our Chronological Age is not the same as our Physiological Age.

• You can be an “old” 55 or a “young” 80.

Current Aging Trends

• Life expectancy in the U.S. went from age 47 to 77 during the last century.

• The fastest-growing age group is age 85 and older.

• 35 million older Americans today will increase to 70 million by 2030.

What Contributes to lack of function?

**Immobility**

Immobility

• Aging of Muscles– Decrease in Muscle function of 30-50% by

age 65.– Muscle fibers become smaller; decreased

number of myofibrils.• Reduction in size, strength, endurance.• Tendency to fatigue more rapidly.

– Decreased cardiovascular function causes less blood flow during activity compared to younger person.

Immobility

• Aging of Muscles (cont.)– Decreased muscle elasticity

• Fibrosis occurs causing increased collagen tissue formation which restricts movement and circulation

• Decreased Cardiovascular function– Decreased elasticity of arterial system

• Decreased Cardiac Output (stroke volume x heart rate)• Decreased Ejection Fraction• Aortic Stenosis

– Decrease in pacemaker cells• Decrease in regulated heart rate

Immobility

• Decreased Cardiovascular function (cont.)– Increased incident of disease, to all systems,

that stress the heart.– Resting heart rate does not decrease, but

maximum heart rate does.• Limits ability to exercise

– Hypertension

Immobility

• Pain (see pain scale on next slide)– If it hurts, you don’t use it.– Arthritis– If Immobility occurs, recovery time in elderly is longer.

• Decline in Memory (will discuss in depth later)– If you don’t remember what you need to do you are

less likely to move.• Psychosocial

– Depression– Isolation

• Loss of ability to drive (Will discuss later)

Pain Assessment Scale

A resident is asked to rate their pain on a numerical scale from 0-10, with 10 representing the worst pain

experience.Resident can be asked the following:

Is the pain constant?Is the pain intermittent?

If pain is relieved what activities or interventions relieve the pain?

How long is the pain relieved?What time of day is the pain the greatest?

When pain affects sleep, how much sleep is obtained in a given period of time?

Describe the medication schedule and the affect of medication on the pain type and duration.

Rating Scale:0 = No Pain

1 = Mild Pain2 = Moderate Pain

3 = Quite A lot of Pain4 = Very Bad Pain

5 = Worst Pain

Pain Scale

0 1 2 3 4 5

Resident is asked to describe the pain as:

Pain Descriptors

S = SharpA = Aching

D = DullB = Burning

C = CrampingN = NumbnessTH = Throbbing

T = Tingling

Immobility

• Decline in Respiratory Function– Not as prominent as cardiovascular function

in the non-smoker.– Decline in oxygen exchange.– Decline in motility of cilia.– Decreased elasticity.

• Decreased inflation/deflation– Lung tissue as well as decrease in rib cage movement.

– On average one foot of membrane is lost every year after age of 30.

Immobility

• 5 Senses (Decline in all five as we age)– Vision-3rd leading cause of disability in the

elderly.• Poor vision can lead to a fear of moving.• Less motivated to get up since we can’t see things.• Can greatly contribute to decline in memory.

– Hearing-unaware of our surroundings.– Touch-Sensation

• Peripheral neuropathy• DM

Immobility

• 5 senses (cont.)– Taste and Smell

• A decline in our taste and smell leads to a decrease in appetite.

• Only 17% of adults over 60 have an appropriate diet.• Decreased Caloric intake

– More processed food

– Less energy

– Less ability for our body to heal

• Decline in Fluid/Water intake.– Decreases elasticity in tissue

A Decline in Mobility leads to a decline in balance.

• Balance is controlled by 3 main factors– Eyes/vision– Vestibular System– Contact with earth

• Muscles• Sensation

How do we affect immobility?

How Do We Affect Immobility?

• As we age we slow down– As caretakers, we don’t allow people enough

time to complete tasks.• We’re in a hurry.• We confuse slow movement with

“struggling” to complete a task.• We feel bad.

– It’s easier for us to do the task for them.– We don’t appropriately modify home to allow

for maximum function and safety.

Effects of Immobility

Cardiovascular

• 12 weeks of bedrest can cause a 15% decline in cardiac muscle mass

– Orthostatic Hypotension

• Decreased pressure sensors

– Decreased Stroke Volume

– Blood Clots

Respiratory

• Decreased respirations cause decreased use of pulmonary tissue

• Fluid build up

• Pooling of secretions– Atelectasis

• Pressure on certain areas of lungs

Digestive Genitourinary

• Constipation• Anorexia• Pain• Diarrhea• Poor Gas/Nutrient

exchange

• Decreased Mobility• Fluid retention• Kidney infection• Limited bladder

emptying• Incontinence

Nervous

• Cognitive decline

• Depression

• Decreased Sensation

• Decreased Pain Sensation

• Decreased Coordination

• Pressure Sores

Musculoskeletal

• 50% muscle mass loss in 3 weeks

• Osteoporosis– Calcium imbalance can affect cardiac function

• Joint fusing

• Decreased joint mobility=decreased balance

• Muscle wasting

Promoting Mobility…

…and Function

Mobility and Function




Dycem



• Wheelchairs• Powerchairs• Power scooters• Stair Climbs• Life Lines• Ramps• Public Transportation• Church Organizations

• Meals on Wheels• Adult Day Centers• Senior Centers• Area office of the

aging• AARP• Association of the

Deaf• Association of the

Blind


• Ramps– ADA says 1:12 Ratio; really

it needs to be at least 1:6.– Maximum rise for any Run

should be 30 inches– Needs to be 36 inches

wide.– Have at least a 2 inch

railing.– Should have at least a 60

inch platform prior to entering structure

– Standard step is 6 inches.

12 in.

1in.

<30 in.2 in.

> 60 in.

Driving

Question: When should someone talk to you about driving?

• Health Change –74%• General Safety Concerns –72%• Forgetful/Getting Lost –71%• Serious accident –50%• Near miss –29%• Minor accident –18%• Older drivers said they were more likely to listen if the

person talking to them had their best interests at heart –focus on the older adult, his/her safety and mobility needs

Driving

• Self-Regulation• Most healthy drivers make their own decisions to cut

back on their driving to stay safe• Older drivers avoid driving:

– At night, or at dusk or dawn– In heavy traffic congestion– On highways or freeways– Long distances– In unfamiliar areas– In poor weather– Making left hand turns

Driving

Who should talk? Who would you be most likely to listen to?

• Married drivers prefer to hear from their spouse, doctor, or adult child.

• Single drivers prefer to hear from their doctor or adult child.

Who would you absolutely not want to hear from?– Married drivers would not want to hear from the police

or DMV or, for some of them, a spouse.– Single drivers would not want to hear from the police

or DMV.

Driving

• www.AARP.ORG

• www.thehartford.com/talkwitholderdrivers

http://www.aarp.org/

http://www.thehartford.com/talkwitholderdrivers

Bladder Control• Check out this link

– http://www.youtube.com/watch?v=bhehwx2u0oE

• Kegel Exercises– Strengthen the Plevic Floor (pubococcygeus) Muscle

The Best way to identify your Pelvic Floor Muscles, is during urination. Once

your flow begins, try to stop it completely. The muscle that you feel tightening is the pelvic floor muscle.

http://www.youtube.com/watch?v=bhehwx2u0oE

Cognition

Cognitive Decline

• Dependent on location of damage in brain– Attention and Concentration– Slowed Processing Speed– Decreased ability to learn– Word Finding/Naming difficulties– Poor Decision-Making– Difficulty Planning/Organizing– Memory Loss

Cognitive Decline

• Irreversible Memory Loss– Alzheimer’s– Vascular Dementia– Lewey Body Dementia– Frontotemporal

Dementia (Social)

• Reversible Memory Loss– Meds/Drugs– Emotional/Depression– Metabloic (Deyhdration)– Sensory Loss– Tumor– Infection– Anemia/B12 Deficiency– NPH

Cognition Strategies

**IF YOU DON’T USE IT, YOU LOSE IT**• Crosswords/Suduko/Word Finds• Puzzles• Reading (Adaptive equipment)• Appointment Calenders/Memo pads• Sticky Notes• Voice Recorders• Alarm Clocks/Timers• Pill Box/Automatic Pill Dispenser• Label Makers/Electronic Spellers

Cognitive Strategies

**IF YOU DON’T USE IT, YOU LOSE IT**

• Color Coding Files/Sorters

• Key Finders

• Written Instructions/Maps/Cue Cards

• Senior Center

• Church Groups

• Coglink.com (Email Address)

Swallowing and Dysphagia

Swallowing

• Normal swallowing involves a complex sequence of movements which occur rapidly and require precise muscle control.

• It takes food/liquids about 2-3 seconds to pass from the back of the mouth to the stomach.

• Difficulty with swallowing is known as Dysphagia.

Dysphagia

• Neurological– CVA– Parkinson’s Disease

• Structural– Stricture– CA– Muscular (age-related)– Diverticulum

• Psychological– Dementia– Fear

Dysphagia

• Leads to Aspiration– Passage of foreign material into the lungs

rather than the stomach.– Aspiration can lead to severe disease or

death.– Approximately 60% of aspiration is silent– Everyone aspirates, however most are

healthy enough to avoid illness.– Approximately 40,000 people die annually

from Dysphagia complications.

Signs of Dysphagia

• Coughing• Choking• Watery eyes• Wet, gurgly voice• Excess chewing• Residual food in mouth• Pocketing• Change in respiration rate• Change in lung

sound/congestion

• Difficulty breathing• Gagging • Chest pain• Pain• Temperature after eating• Report of “something

stuck in throat” • Multiple swallows• Attempts to clear throat• Pneumonia or chronic

URI

3 Ounce Water Test

• Quick and easy test to check for dysphagia:– Pour 3 ounces of water into a cup– Have patient drink the water taking

normal sips, as many as needed, but they must be continual.

– Look for any difficulty with swallowing or inability to drink the full glass in one attempt.

Diagnosing Dysphagia

• Refer to a Physician

• Refer to Speech and Language Pathologist (SLP)/Speech Therapist

• Video Esophagram

• Modified Barium Swallow

• ENT to rule out Esophageal causes

Correct Swallowing“chin tuck”

Incorrect Swallowing

Beyond head neutral

Aspiration Prevention Tips

• Make sure patient is awake/alert.• Small Bites (1/2-1 Teaspoon).• Enourage coughing/clearing airways.• Allow time to swallow and re-swallow.• Relax!!!• Place Spoon on tongue, not in mouth• Watch for larynx to rise and fall• Ensure mouth is empty• Present liquids from midline or below…Not

above.

Aspiration Prevention Tips (cont.)

• Do not Dump liquids in mouth• Alternate liquids and solids. Drink after every 2-3

bites.• Alternate hot and cold items.• END THE MEAL WITH A LIQUID.• Make sure patient remains upright 30 minutes

after meal.• Do not “drown” a cough.• We should take each pill with 4 ozs. of water.

Feeding Posture

DO’s• Sit upright with hips at 90

degrees of flexion• Head at 45 degrees of

natural flexion.• Head should not be

hyper-extended.• Make sure dentures are

in• And glasses are on, with

proper lighting.

DON’Ts• Extend head and neck

forward• Sunken chest• Rounded shoulders• Leaning• Protruding abdomen• Slouching

Dysphonia

Dysphonia

• Disorder of the voice; inability to produce voice using voice organs. – A phonation problem– Different from dysarthria, which is a condition

of the voice muscles.

• Weakness• Breathiness• Hoarseness• Strained/struggled

Dysphonia Causes• Voice Misuse and Abuse

– Yelling– Smoking

• Trauma – Heat– Blunt

• Nervous System– ALS– MS– PD– Huntington’s Chorea

• Organic Disease– Granulomas– Cancer

Dysphonia Signs

• Horseness• Breathiness• Tension• Tremor• Strained-Strangled• Pitch Breaks• Monopitch• Monoloudness• Glotial Fry

Dysphonia Treatments

Always consult with ENT• Decrease amount of talking• Decrease loudness/Whisper• Limit Caffeine• Eliminate vocal abuse

– Smoking– Throat clearing– Alcohol– Environment

• Extra hydration• Speech Therapy• Humidify air• GERD management

HOME SAFETY

Home Safety Tips:

• Good Lighting• Eliminate floor rugs• Eliminate clutter• Eliminate unneeded

furniture• Elevate height of

chairs/bed• Safety Rails/Grab bars• Non-skid mats on all non-

carpeted floors

• Non-skid shoes/socks– Avoid high heels– Avoid slippers– Avoid hard soled shoes– Avoid shoes without backs

• Tub bench• Dry Floors• Skids in Shower• Place frequently used

objects at most accessible locations

Home Safety Tips (cont.)

• Don’t ever stand on a chair or stool

• Keep phone within reach

• Emergency numbers handy

• Pets!!!!!!!

• Remove doorway thresholds or have them covered

• Keep Electrical Cords out of the way

Energy Conservation

• Remember we want to maximize function• Prioritize tasks that need to get done

– Use planner to assist plan of day/week

• Sit instead of stand to do activities– Dressing– Shower– Cooking– Folding laundry– Ironing

• Use a lightweight cart to move objects

Energy Conservation (cont.)

• Take breaks to preserve energy

• Minimize trips up and down stairs

• Use of energy saving tools– Reachers– Shower brushes– Electric can opener– Electric razor– Dishwasher

Energy Conservation (cont.)

• USING PROPER BODY MECHANICS:– Sit and stand with good posture– Lift with your legs, keeping your back straight– Keep your nose and toes pointed in the same

direction; do not twist your trunk– Push . . . don’t pull– Slide . . . don’t lift– When need be, use both hands to carry items

and hold them close to your body

FALLS

• In the U.S. one of every three people older than age 65 fall each year.

• Falls are the most common cause of injuries and hospital admissions for trauma among the elderly, and are recognized as a leading cause of injury and death in the aged.

• 50% of all fallers fall repeatedly.• 9,500 elderly deaths each year are related to falls.• Falls account for 87% of all fracture among people aged

65 or older and are the second leading cause of spinal cord and brain injury.

• The economic cost of osteoporotic fracture will exceed $45.2 billion annually.

FALLS (cont.)

• Half of all elderly adults hospitalized for hip fractures cannot return home or live independently after the facture.

• For people aged 65 or older, 60% of fatal falls occur in the home, 30% occur in public places, and 10% occur in healthcare institutions.

• Risks of falls increases proportionally with age.• Half of those over age 75 who fracture a hip as a result

of a fall die within 1 year of the incident.• Between 50% to 90% of elders who report a fall admit to

restricting their activities for fear of another fall.

Fall Risk Factors

Medications that Contribute to Falls

Balance Tests

• Center for Disease Control– www.cdc.gov/

• Home Safety Council– www.homesafetycouncil.org/

http://www.cdc.gov/

http://www.homesafetycouncil.org/

Rehabilitation Goals 1. Does your family member plan to return home? ____________________ If so, will they live alone? ______________________________________

2. Was your family member walking before this recent hospitalization? ____ Used a cane? _____ Used a walker? ____

Used a wheelchair? ____ Do they have their own wheelchair? _______ How long has it been since they last walked? ______________________

How far where they able to walk? _____________ 3. Was your family member able to bath and dress independently? ________

How much help was needed? ___________________________________ 4. Did your family member use the bathroom for toileting? ______________

Did they depend on undergarment pads or briefs? __________________ 5. Does your family member have difficulty eating or swallowing? ________ ___________________________________________________________

6. Have you noticed any increase in confusion or memory problems? ______ ____________________________________________________________

7. What are your goals for your family member’s rehabilitation? ____________________________________________________________

Exercise ProgramAdapted from “Exercise and Physical Activity, Your Everyday Guide from The

National Institute on Aging”

• Even very small changes in muscle strength can make a real difference in function, especially in people who have already lost a lot of muscle. An increase in muscle that you can’t even see can make it easier to do everyday things like get up from a chair, climb stairs, carry groceries, open jars, and even play with your grandchildren. Lower body strength exercises also will improve your balance.

• Depending on your condition, you might need to start out using 1-pound or 2-pound weights or no weight at all. Your body needs to get accustomed to strength exercises.

Exercise ProgramAdapted from “Exercise and Physical Activity, Your Everyday Guide from

The National Institute on Aging”

• Use a light weight the first week; then gradually add more weight. Starting out with weights that are too heavy can cause injuries.

• Gradually add more weight in order to benefit from strength exercises. You need to challenge your muscles to get the most benefit from strength exercises. (The Progressing section will tell you how). – It should feel somewhere between hard and very hard for you to

lift or push the weight. It shouldn’t feel very, very hard. If you can’t lift or push a weight 8 times in a row, it’s too heavy for you. Reduce the amount of weight.

– Take 3 seconds to lift or push a weight into place, hold the position for 1 second, and take another 3 seconds to return to your starting position. Don’t let the weight drop; returning it slowly is very important.

– Try to do 10 to 15 repetitions for each exercise. Think of this as a goal. If you can’t do that many at first, do as many as you can. You may be able to build up to this goal over time.



• Safety – Talk with your doctor if you are unsure about doing a particular

exercise. For example, if you’ve had hip or back surgery, talk about which exercises might be best for you.

– Don’t hold your breath during strength exercises. Holding your breath while straining can cause changes in blood pressure. This is especially true for people with heart disease.

– Breathe regularly. Breathe in slowly through your nose and breathe out slowly through your mouth. If this is not comfortable or possible, breathe in and out through either your nose or mouth.

– Breathe out as you lift or push, and breathe in as you relax. For example, if you’re doing leg lifts, breathe out as you lift your leg, and breathe in as you lower it. This may not feel natural at first and you probably will have to think about it for a while as you do it.



• Safety (cont.)– Proper form and safety go hand in hand. For some exercises,

you may want to start alternating arms and work your way up to using both arms at the same time. If it is difficult for you to hold hand weights, try using wrist weights.

– To prevent injury, don’t jerk or thrust weights into position. Use smooth, steady movements.

– Avoid “locking” your arm and leg joints in a tightly straightened position. To straighten your knees, tighten your thigh muscles; this will lift your kneecaps and protect them.

– Muscle soreness lasting a few days and slight fatigue are normal after muscle-building exercises, at least at first. After doing these exercises for a few weeks, you will probably not be sore after your workout.



• Progressing: Muscle strength is progressive over time. – Gradually increase the amount of weight you use to build

strength. When you can do 2 sets of 10 to 15 repetitions easily, increase the amount of weight at your next session.

– Here is an example of how to progress gradually: Start out with a weight that you can lift only 8 times. Keep using that weight until you become strong enough to lift it easily 10 to 15 times.

– When you do 2 sets of 10 to 15 repetitions easily, add more weight so that, again, you can lift it only 8 times.

– Keep repeating until you reach your goal, and then maintain that level as long as you can.



• Working with a Resistance Band: Resistance bands are stretchy elastic bands that come in several strengths, from light to heavy. You can use them in some strength exercises instead of weights. – 1. Lay the band flat in your hand with the end toward your pinky finger. – 2. Wrap the long end of the band around the back of your hand. – 3. Grasp firmly.

• If you are a beginner, try exercising without the band until you are comfortable; then add the band. – Choose a light band if you are just starting to exercise, and move on to

a stronger band when you can do 2 sets of 10 to 15 repetitions easily. – Hold on to the band tightly (some bands have handles), or wrap it

around your hand or foot to keep it from slipping and causing possible injury.

– Do the exercises in a slow, controlled manner, and don’t let the band snap back.

Courtesy of Rehabcare's Smart Moves Program.

Exercises

Hand Grip: This simple exercise should help if you have trouble picking things up or holding on to them. It also will help you open things like that pickle jar more easily. You can even do this exercise while reading or watching TV.

1. Hold a tennis ball or other small rubber or foam ball in one hand. 2. Slowly squeeze the ball as hard as you can and hold it for 3-5 seconds. 3. Relax the squeeze slowly. 4. Repeat 10-15 times. 5. Repeat 10-15 times with other hand. 6. Repeat 10-15 times more with each hand.


Exercises

Wrist Curl: This exercise will strengthen your wrists. It also will help ensure good form and prevent injury when you do upper body

strength exercises.

1. Rest your forearm on the arm of a sturdy chair with your hand over the edge.

2. Hold weight with palm facing upward.

3. Slowly bend your wrist up and down.

4. Repeat 10-15 times.

5. Repeat 10-15 times with other hand.

6. Repeat 10-15 more times with each hand.


Exercises

Overhead Arm Raise: This exercise will strengthen your shoulders and arms. It should make swimming and other activities such as lifting and carrying grandchildren easier.

1. You can do this exercise while sitting in a sturdy, armless chair of standing. 2. Keep your feet flat on the floor, shoulder width apart. 3. Hold weights at your sides at shoulder height with palms facing forward. Breathe in slowly. 4. Slowly breathe out as you raise both arms up over your head keeping your elbows slightly bent. 5. Hold the position for 1 second. 6. Breathe in as you slowly lower your arms. 7. Repeat 10-15 times. 8. Rest; then repeat 10-15 more times.

• As you progress, use a heavier weight and alternate arms until you can lift the weight comfortably with both arms.


Exercises

Front Arm Raise: This exercise for your shoulders can help you put things up on a shelf or take them down more easily.

1. Stand with your feet shoulder width apart. 2. Hold weights straight down at your sides with palms facing backward. 3. Keeping them straight, breathe out as you raise both arms in front of you to shoulder height. 4. Hold the position for 1 second. 5. Breathe in as you slowly lower arms. 6. Repeat 10-15 times. 7. Rest; then repeat 10-15 more times.



Exercises

Side Arm Raise: This exercise will strengthen your shoulders and make lifting groceries easier.

1. You can do this exercise while sitting in a sturdy, armless chair or standing. 2. Keep your feet flat on the floor shoulder width apart. 3. Hold hand weights straight down at your sides with palms facing inward. Breathe in slowly. 4. Slowly breathe out as you raise both arms to the side, shoulder height. 5. Hold the position for 1 second. 6. Breathe in as you slowly lower your arms. 7. Repeat 10-15 times. 8. Rest; then repeat 10-15 more times.



Exercises

Arm Curl: After a few weeks of doing this exercise for your upper arm muscles, lifting that gallon of milk will be much easier.

1. Stand with your feet shoulder width apart. 2. Hold weights straight down at your sides with palms facing forward. Breathe in slowly. 3. Breathe out as you slowly bend your elbows and lift weights toward chest. Keep elbows at your sides. 4. Hold the position for 1 second. 5. Breathe in as you slowly lower your arms. 6. Repeat 10-15 times. 7. Rest; then repeat 10-15 more times.



Exercises

Arm Curl with Resistance Band: This variation of the Arm Curl uses a resistance band instead of weights. (See Working with a Resistance Band.)

1. Sit in a sturdy, armless chair with your feet flat on the floor shoulder width apart. 2. Place the center of the resistance band under both feet. Hold each end of the band with palms facing inward. Keep elbows at your sides. Breathe in slowly. 3. Keep wrists straight and slowly breathe out as you bend your elbows and bring your hands toward your shoulders. 4. Hold the position for 1 second. 5. Breathe in as you slowly lower your arms. 6. Repeat 10-15 times. 7. Rest; then repeat 10-15 more times.

• As you progress, use a heavier strength band.


ExercisesSeated Row with Resistance Band: This exercise to strengthen upper back, shoulder and neck muscles should make everyday activities such as raking and vacuuming easier. (See Working with a Resistance Band.)

1. Sit in a sturdy, armless chair with your feet flat on the floor shoulder width apart. 2. Place the center of the resistance band under both feet. Hold each end of the band with palms facing inward. 3. Relax your shoulders and extend your arms beside your legs. Breathe in slowly. 4. Breathe out slowly and pull both elbows back until your hands are at your hips. 5. Hold the position for 1 second. 6. Breathe in as you slowly return your hands to the starting position. 7. Repeat 10-15 times. 8. Rest; then repeat 10-15 more times.

• As you progress, use a heavier Strength band.


Exercises

Wall Push-Up: These push-ups will strengthen your arms, shoulders, and chest. Try this exercise during a TV commercial break.

1. Face a wall, standing a little farther than arm’s length away, feet shoulder-width apart. 2. Lean your body forward and put your palms flat against the wall at shoulder height and shoulder width apart. 3. Slowly breathe in as you bend your elbows and lower your upper body toward the wall in a slow, controlled motion. Keep your feet flat on the floor. 4. Hold the position for 1 second. 5. Breathe out and slowly push yourself back until your arms are straight. 6. Repeat 10-15 times. 7. Rest; then repeat 10-15 more times.


ExercisesElbow Extension: This exercise will strengthen your upper arms. If your shoulders aren’t flexible enough to do this exercise, try the Chair Dip.

1. You can do this exercise while sitting in a sturdy, armless chair or standing. 2. Keep your feet flat on the floor shoulder width apart. 3. Hold weight in one hand with palm facing inward. Raise that arm toward ceiling. 4. Support this arm below elbow with other hand. Breathe in slowly. 5. Slowly bend raised arm at elbow and bring weight toward shoulder. 6. Hold the position for 1 second. 7. Breathe out and slowly straighten your arm over your head. Be careful not to lock your elbow. 8. Repeat 10-15 times. 9. Repeat 10-15 times with other arm. 10.Repeat 10-15 more times with each arm.

• If it is difficult for you to hold hand weights, try using wrist weights.


Exercises

Chair Dip: This pushing motion will strengthen your arm muscles even if you are not able to lift yourself up off the chair.

1. Sit in a sturdy chair with armrests with your feet flat on the floor, shoulder width apart. 2. Lean slightly forward; keep your back and shoulders straight. 3. Grasp arms of chair with your hands next to you. Breathe in slowly. 4. Breathe out and use your arms to push your body slowly off the chair. 5. Hold position of 1 second. 6. Breathe in as you slowly lower yourself back down. 7. Repeat 10-15 times. 8. Rest; then repeat 10-15 more times.


Exercises

Back Leg Raise: This exercise strengthens your buttocks and lower back. For an added challenge, you can modify the exercise to improve your balance. (See Progressing to Improve Balance)

1. Stand behind a sturdy chair, holding on for balance. Breathe in slowly. 2. Breathe out and slowly lift one leg straight back without bending your knee or pointing your toes. Try not to lean forward. The leg you are standing on should be slightly bent. 3. Hold the position for 1 second. 4. Breathe in as you slowly lower your leg. 5. Repeat 10-15 times. 6. Repeat 10-15 times with other leg. 7. Repeat 10-15 more times with each leg.

• As you progress, you may want to add ankle weights.


Exercises

Side Leg Raise: This exercise strengthens your hips, thighs, and buttocks. For an added challenge, you can modify the exercise to improve your balance. (See Progressing to Improve Balance.)

1. Stand behind a sturdy chair with feet slightly apart, holding on for balance. Breathe in slowly. 2. Breathe out and slowly lift one leg out to the side. Keep your back straight and your toes facing forward. The leg you are standing on should be slightly bent. 3. Hold the position for 1 second. 4. Breathe in as you slowly lower your leg. 5. Repeat 10-15 times. 6. Repeat 10-15 times with other leg. 7. Repeat 10-15 more times with each leg.



Exercise

Knee Curl: Walking and climbing stairs are easier when you do both the Knee Curl and Leg Straightening exercises. For an added challenge, you can modify the exercise to improve your balance. (See Progressing to Improve Balance.)

1. Stand behind a sturdy chair, holding on for balance. Lift one leg straight back without bending your knee or pointing your toes. Breathe in slowly. 2. Breathe out and slowly bring your heel up toward your buttocks as far as possible. Bend only from your knee, and keep your hips still. The leg you are standing on should be slightly bent. 3. Hold the position for 1 second. 4. Breathe in as you slowly lower your foot to the floor. 5. Repeat 10-15 times. 6. Repeat 10-15 times with other leg. 7. Repeat 10-15 more times with each leg.



Exercises

Leg Straightening: This exercise strengthens your thighs and may reduce symptoms of arthritis of the knee.

1. Sit in a sturdy chair with your back supported by the chair. Only the balls of your feet and your toes should rest on the floor. Put a rolled bath towel at the edge of the chair under thighs for support. Breathe in slowly. 2. Breathe out and slowly extend one leg in front of you as straight as possible, but don’t lock your knee. 3. Flex foot to point toes toward the ceiling. Hold position for 1 second. 4. Breathe in as you slowly lower your leg back down. 5. Repeat 10-15 times. 6. Repeat 10-15 times with other leg. 7. Repeat 10-15 more times with each leg.



Exercises

Chair Stand: This exercise strengthens your abdomen and thighs, will make it easier to get in and out of the car. If you have knee or back problems, talk with your doctor before trying this exercise.

1. Sit toward the front of a sturdy, armless chair with knees bent and feet flat on the floor, shoulder width apart. 2. Lean back with your hands crossed over your chest. Keep your back and shoulders straight throughout the exercise. Breathe in slowly. 3. Breathe out and bring your upper body forward until sitting upright. 4. Extend your arms so they are parallel to the floor and slowly stand up. 5. Hold the position for 1 second. 6. Breathe in as you slowly sit down. 7. Repeat 10-15 times. 8. Rest; then repeat 10-15 more times.

• People with back problems should start the exercise from the sitting upright position.


Exercises

Toe Stand: This exercise will help make walking easier by strengthening your calves and ankles. For an added challenge, you can modify the exercise to improve your balance. (See Progressing to Improve Balance.)

1. Stand behind a sturdy chair, feet shoulder width apart, holding on for balance. Breathe in slowly. 2. Breathe out and slowly stand on tiptoes as high as possible. 3. Hold the position for 1 second. 4. Breathe in as you slowly lower your heels to the floor. 5. Repeat 10-15 times. 6. Rest; repeat 10-15 more times.

• As you progress, try doing the exercise standing on one leg at a time for a total of 10-15 times on each leg.



• How to Improve Your Flexibility – Stretching or flexibility exercises are an important part of your

physical activity program. – They give you more freedom of movement for your physical

activities and for everyday activities such as getting dressed and reaching objects on a shelf.

– Stretching exercises can improve your flexibility, but will not improve your endurance or strength.

• How Much, How Often – Do each stretching exercise 3 to 5 times at each session. – Slowly stretch into the desired position, as far as possible

without pain, and hold the stretch for 10 to 30 seconds. Relax, breathe, then repeat, trying to stretch farther.



• Safety – Talk with your doctor if you are unsure about a particular exercise. For example, if

you’ve had hip or back surgery, talk with your doctor before doing lower-body exercises.

– Always warm-up before stretching exercises. Stretch after endurance or strength exercises. If you are doing only stretching exercises, warm up with a few minutes of easy walking first. Stretching your muscles before they are warmed up may result in injury.

– Always remember to breathe normally while holding a stretch. – Stretching may feel slightly uncomfortable; for example, a mild pulling feeling is

normal. – You are stretching too far if you feel sharp or stabbing pain, or joint pain – while

doing the stretch or even the next day. Reduce the stretch so that it doesn’t hurt. – Never “bounce” into a stretch. Make slow, steady movements instead. Jerking into

position can cause muscles to tighten, possibly causing injury. – Avoid “locking” your joints. Straighten your arms and legs when you stretch them, but

don’t hold them tightly in a straight position. Your joints should always be slightly bent while stretching.

• Progressing – You can progress in your stretching exercises. For example, as you become more

flexible, try reaching farther, but not so far that it hurts.


Flexibility Exercises

















Special Thanks

• RehabCare: A Division of Kindred HealthCare

• Melanie Heck

• Susan Bolash

Functional Issues in Older Adults Jordan Bicher, D.P.T Director of Rehabilitation; Physical Therapist.

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